Backlog cleanup · Telehealth & digital health
Backlog cleanup · Telehealth & digital healthCleared 60-day claim backlog across 22 states without missing a timely-filing window.
A national behavioral-health telehealth platform inherited a 60-day claim backlog across 22 states after a prior-vendor failure. Medonix surge coders cleared the backlog in 31 days with zero timely-filing breaches, then standardized the multi-state telehealth playbook for ongoing operations.
- Telehealth & digital health · Behavioral health
- Client: National telehealth platform
- State: 22 states
- Backlog cleanup
Outcome at a glance
Before and after, on the metrics that mattered.
Backlog claims
Time to zero
Timely-filing breaches
The situation
Where the practice was when Medonix engaged.
A national behavioral-health telehealth platform serving patients across 22 states discovered, after a quarterly close, that their billing vendor had effectively stopped working their queue for the prior 45 days. Approximately 14,200 claims sat in submission and follow-up backlog, with the oldest claims approaching timely-filing windows in several state Medicaid plans.
The platform's CFO and COO needed a vendor that could deploy surge capacity within days, not weeks, and that could navigate the multi-state telehealth payer-rule complexity (POS 02 vs POS 10, modifier 95 vs GT, audio-only allowances, state parity laws) without dropping further claims.
Two vendors quoted 60-day surge-deployment timelines. Medonix quoted 48 hours to first surge coder deployment and 30 days to full backlog clearance. The platform engaged Medonix that week.
The work
What Medonix actually did.
Within 48 hours of contract sign, a team of 22 AAPC-credentialed coders (one per state to handle state-specific Medicaid and parity rules) deployed to the platform's queue. AI Coding handled high-volume, lower-complexity claim types in parallel to free coder capacity for state-specific edge cases.
Triage sorted the 14,200-claim backlog by remaining timely-filing days. Claims under 30 days from filing deadline were worked first, regardless of date of service order. The team cleared 4,600 timely-filing-at-risk claims inside the first 10 days.
In parallel, Medonix built the standardized multi-state telehealth playbook with state-by-state payer-rule logic, POS / modifier per service per state, and a quarterly update cycle against CMS and state Medicaid policy releases. The platform transitioned to ongoing Medonix operations after the backlog cleared.
The outcome
Where the practice landed.
The 14,200-claim backlog cleared in 31 days with zero timely-filing breaches. Recovered cash from previously-stalled claims totaled approximately $4.8M over the next two months as the cleared queue moved through payer adjudication.
For ongoing operations, the multi-state telehealth playbook now runs on a 99% first-pass clean-claim rate measured at the payer, with a quarterly review against state-specific policy changes baked into the engagement.
The platform's COO has presented the recovery story at two HIMSS sessions and one Becker's Hospital Review event.
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